USE REFERRAL FORM

Use this fillable PDF referral form. Complete, print, and fax or fax directly from your computer.

This form is provided as a courtesy. It is preferred but not required for referrals. Any standard Fax referral that provides equivalent information is acceptable.

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CALL US

509-456-5433

Tell us about your patient.

Do you have a question or a case you would like to discuss?

Please leave a message and Dr. P will do his best to return your call before the end of the workday.

To refer a patient please fax a referral to: 509-456-3557

Please be sure to include:

Demographics
Insurance information
Reason for referral
Requested consult and/or procedure(s)
Recent or relevant notes, labs, radiology reports

CLINICAL RESEARCH

Spokane Gastroenterology is actively involved in clinical research

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Procedures

Colonoscopy

EGD

Esophageal Dilation

Capsule Endoscopy

Pouchoscopy

Flexible Sigmoidoscopy

Fast Track Endoscopy

USE REFERRAL FORM

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To refer a patient please fax a referral to: 509-456-3557

CLINICAL RESEARCH

Spokane Gastroenterology is actively involved in clinical research

PROVIDER INFORMATION

1

3

Procedures

Tel: (509)456-5433
Fax: (509)456-3557

USE REFERRAL FORM

2

To refer a patient please fax a referral to: 509-456-3557

CLINICAL RESEARCH

Spokane Gastroenterology is actively involved in clinical research

PROVIDER INFORMATION

1

3

Procedures

Tel: (509)456-5433 Fax: (509)456-3557

Tel: (509)456-5433
Fax: (509)456-3557